What is at stake for payers? Not only do unwarranted c-sections create greater health risks for women and babies, this study shows that they also dramatically increase costs for employers and, through Medicaid programs, state and federal budgets. Medicaid programs paid nearly $4,000 more for c-sections than vaginal births, while for commercial insurers the difference topped $9,500. The World Health Organization recommends a c-section rate of 15% or less for any country. If the U.S. c-section rate was reduced from 33% to 15%, national spending on maternity care would decline by more than $5 billion each year.
This was just one of the important findings in The Cost of Having a Baby in the United States. Download the report to view more. These data provide needed groundwork for improvement programs to align maternity care payment and quality. As governments and businesses work to balance budgets, and zero in on the costly maternity care segment, we must target the areas where we can reduce cost while simultaneously improving health and safety. High-quality, high-value care is within reach. We must rapidly spread innovation and best practices to improve the health of women, babies, and families. We can’t afford not to.
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THE COST OF HAVING A BABY IN THE UNITED STATES
Better care, better outcomes, and lower costs in health care are all possible through use of innovative delivery systems, supported by value-based payment systems and effective performance measurement. One of the greatest opportunities for improving health care value is in maternity care, which impacts everyone at the beginning of life and about 85% of women during one or more episodes of care. Most childbearing women are healthy, have healthy fetuses, and have reason to expect an uncomplicated birth, yet routine maternity care is technology-intensive and expensive: combined maternal and newborn care is the most common and costly type of hospital care for all payers, private payers, and Medicaid. Childbirth Connection, Catalyst for Payment Reform, and the Center for Healthcare Quality and Payment Reformcommissioned this report to focus the attention of all stakeholders on the need to better align maternity care payment and quality.
In this study, “cost” is measured by the amount that employers, Medicaid managed care plans, Medicaid programs, and others pay hospitals, clinicians, and other service providers. These payments are typically discounted considerably relative to the amount charged by the various service providers.
This study provides many separate cost analyses, including:
- cesarean versus vaginal birth
- Medicaid versus Commercial insurance costs
- out-of-pocket payments
- type of service (facility, provider, lab, anesthesiology, imaging, and pharmacy)
- phase of care (prenatal, intrapartum, and postpartum)
- cost variation across selected states (maternal only)
- neonatal intensive care unit costs
- comparison of commercial payer and out-of-pocket maternal costs in 2004 and 2010
Download: The Cost of Having a Baby in the United States (PDF)
Download: Executive Summary (PDF)
Download: Press Release (PDF)
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